Sunday, December 31, 2006

Happy New Year!!

Thursday, December 28, 2006

Food for Thought

Here are some poignant quotes from the movie, A Beautiful Mind:

John Nash: I've gotten used to ignoring them and I think, as a result, they've kind of given up on me. I think that's what it's like with all our dreams and our nightmares, Martin, we've got to keep feeding them for them to stay alive.

Nash: I still see things that are not here. I just choose not to acknowledge them. Like a diet of the mind, I just choose not to indulge certain appetites.

Monday, December 25, 2006

Are you on Autopilot?

Saw the movie "Click" - Adam Sandler, Kate Beckingsdale, Christopher Walken. If you haven't seen it yet, you might not want to read further.

It was an interesting movie. Adam Sandler is an architect with a wife and two kids. He's a workaholic because his boss expects it, because he wants to make partner to make a lot of money, and because he wants to keep up with the rich family next door. He constantly misses out on home life because of work, missing swim meets, school meetings, dinner, and the like, and still feels tremendous pressure to do more and more at work. And because he's never at home, he does not know how to operate all the separate remote controls (one for fan, one for TV, one for garage, etc). One night, he decides that he is going to buy a universal remote control, because the Jones' next door have one, and it will simplify his life. And on that fateful night, Bed Bath and Beyond is the only store open.He wanders the aisle looking for a remote control, and ends up plopping on a comfortable bed. We then join him as he finds himself in the storage part of the building, where he meets Walken, and actually finds this universal remote control. Only it's more than he bargained for - it can control his world.As he spends the next few days figuring out how to work the remote, he realizes that it can do whatever he wants. His life is recorded like a DVD. He can choose to go back to specific times in the past. He can pause life. He can even fast forward through the "boring" and the "bad" (sitting in traffic, taking a shower, foreplay/sex, arguing with his wife). Given this knowledge, one night he gives in to the temptation to forward to the time when he has finally become partner. His boss had been dangling this carrot for the longest time, and the latest promise was that he would make partner in two months. So he chooses to fast forward to that point in time. Only it ends up to be one year later, because the boss kept on stringing him along.So now it's one year later, and the only thing he knows is that he has made partner. During the time that he fastforwarded, "he" was still in the "movie" but functioning on "autopilot" - an emotionally removed, distracted participant in his own life. He misses out on a year of his kids' life. His marriage is now on the rocks. Then the remote goes crazy. Based on the "user preferences," it decides to fast forward every time he tries to do what he fastforwarded through before. He can no longer sit in traffic. He can't take a shower. He's fastfowarded through sex. And most importantly, it fastforwards him to his next promotion, which happens ten years later.The ten year older Sandler is wildly successful at work, but his personal life is a mess. He is grossly overweight. His wife divorced him. He doesn't recognize his children. His beloved dog passed away. And his father died as well. Driven mad by this last finding, he commands the remote to take him back to the last time he saw his dad. And he watches his autopilot self brush off his father's last attempt to connect with him. The next promotion/fastforward takes him to his son's wedding. His son is now an architect at his firm, with a work ethic learned from his father. At the wedding, he has a massive heart attack and ends up in the hospital, on futuristic life support. His children visit him, and he learns that his son is about to skip over his honeymoon because an emergency came up at work. The children are ushered away by a nurse. This realization, that his son has become a replica of his younger self greatly pains him, and he decides to rush after them to tell them his hard learned life lesson. He succeeds in telling them that "family is what matters most," but dies in the process, because he self-disconnected from the life support to get to them.Then he wakes up on the BBB bed, elated to find that this was only a fateful and pivotal dream. With this newfound truth, he becomes a new man.

While parts of the movie were a little hard to believe, overall, it should touch a lot of America. After all, how many people do you know who are stuck in a rat race that they hate, yet cannot get out of? And the final lesson is such a beautiful and easily forgotten truth - that money, fame, power, means little on a deathbed. That what matters most is who you were and how you mattered to those around you. That the seemingly insignificant things in life, even daily annoyances like sitting in traffic, are all little packets of life, strung together to make a majestic whole. That in an era of outsourcing, to miss out on any of these is to miss out on living.

At this contemplative time of year, my wish is that we can all remember to take off the blinders and see life for what it truly is. Sometimes frustrating, sometimes boring, but when it's all said and done, always worth living. And that "meaningful" is less what is actually happening, and more what we take out of the experience.

Thursday, December 21, 2006

Are You a Face Reader?

We see a lot of patients in each clinic. And in derm, you have to be observant, because you don't want to miss something that may be a clue to the medical problem.

One of the observations that have come about, unintentionally, is that people's personalities affect what they look like. Now that may be obvious - someone who's extremely depressed may look unkempt, but I'm talking about more subtle changes. Like changes in their face.

I'm not talking about physiognomy, which may or may not have its merits - I don't know enough about the field to comment on that. But when you see many elderly patients, you realize that there's a group that is very happy, a group that is very unhappy, and then many people in between these two extremes. And the surprising thing is that you can often sense what kind of person they are when you walk in the room - some have a kind, open face. Others have this peaceful, happy expression. Still others have the years of pain and anguish etched into the lines on their face. Talking with them helps confirm the initial impression.

I'm not saying that first impressions are always correct, or that facial features always accurately represent the bearer's personality - we've all seen psychopaths with trusting faces (think Scott Peterson). And I think a person's "active" personality (the side they show to the public) is very different (and often looks different) than their "passive" face when they are deep in thought, or not aware that others are looking. I just think that the latter is interesting because it seems to correlate somewhat with the person's views on life and living...

All this sounds a little hokey. But it makes some sense - if you're always worried, it's normal to have worry lines form. Or if you smile a lot, the wrinkles around the eyes often curve up. And then there are the microexpressions, which have actually been studied in depth by Paul Ekman. What do you think?

Sunday, December 10, 2006

Nursing Homes

I've become afraid of nursing homes. Not because of the residents of these homes, but in some ways, because of the residents of these homes. Let me explain.

If you've read prior posts, you know how I feel about the elderly. I think they can be enormous sources of wisdom and, at their best, remarkable role models for our generation. So why the dislike of nursing homes? Because every time I'm going there, it's to see a patient with a rash. There's a point to the visit, and time is limited, because I have to get back to clinic, or head on over to see the next patient.

What does that mean? If you've never been to a nursing home, try to picture this: sterile white hallways with a series of open doors on either side. In the hallway, or near the nursing station, there are nursing home residents in wheelchairs. They are bundled up in the warmest of wool and blankets. Most look around listlessly, and some don't even make eye contact. The most heart-wrenching part is when one of them makes eye contact and his eyes light up, thinking that someone is coming to visit, or to talk with him, and when he realizes you're not slowing down, the same light goes out, and he goes back to looking at the ground.

You say hello, but what more can you do? If I had all the time in the world, I would stop and visit with each one. I would learn what makes that person tick, relive their experiences, and validate that who they are is important. And my life would probably be that much better, had I the luxury of time to learn from them - people whose collective experience represent a pool of knowledge far greater than can be learned by oneself.

But how are we to make this time? If you were to stop for one, how could you not stop for the next? And if you stop for them all, how would you ever make it back to clinic? Some of us solve this dilemma by not looking. Speed up the walk, keep the eyes forward. But to ignore these people and these feelings is to deny their, and your own, humanity. That's not the solution. Although I'm not sure what is.

Tuesday, December 05, 2006

Big Tobacco And Your Child

Did you know that there are people out there who target your children for a living?

There are jobs where people sit around and think of ways to "reach out to" (aka brainwash) your child. It's rampant. While some of the things done are relatively benign - putting sugary, colorful cereals on a low shelf (your knee level, but smack in front of your little kid), others are not.

While I knew this on an intellectual level, only recently did I see it in action. Kool sent my little cousin a "free" gift: a classy, portable, silver colored domino set. Included in the gift was a pamplet with barely legal MTV-ish models on the cover, drinking and having a good time. Here are some excerpts from said pamphlet:

"Welcome to Kustom, where self-expression is always in style. Use the domino set we sent you to fine-tune your strategy, then take your skills to www.kool.com"

"No pad is complete without a kicking home theather or sound system. Get sound advice from an expert at www.kool.com"

Remind me again - what was that website you're trying to ingrain into some poor 12 year old's head? There's no mention of smoking or cigarettes in any of the gift contents, but if they can lure you to the website (the actual website name being www.smokerswelcome.com, a more truthful title), they've got their fishing line in the water.

I've no idea how these people sleep at night. They should be forced to spend some time with an end stage emphysema or lung cancer patient and see them gasp for air before a miserable death. Then try to go back and hook little kids to make a profit.

Granted, there are people sitting around thinking of ways to brainwash adults as well. And, by the looks of our huge consumer economy, they do a pretty darn good job of it. Hey, I'm all for free choice. If you're 35 years old and make a conscious, educated decision to do something detrimental to your health, it's your choice. But while it's one thing to make an adult really, really want to buy something, it's seems wrong for them to target children. After all, if we don't think they should drink or vote before the age of 18 or 21, shouldn't it be illegal for anyone to tempt them with cancer sticks before they're old enough to know better?